Outline of the Lymphatic System of the Back

Rickenbacher, Josef; Landolt, Alex M.; Theiler, Karl; Scheier, Heinrich; Siegfried, J.; Wagenhäuser, F. J.; Wilson, R. R.; Winstanley, Diana

doi:10.1007/978-3-662-05791-9_7

Cited by 2 publications

(2 citation statements)

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“…The decreased pulsatile frequencies generally observed on the back ( Table 2 , Figure 2 ), and the finding that back lymphatic collectors travel from medial to lateral along dermatomal patterns ( Supplementary Videos 1A and 1B ) was clearly demonstrated, but it is not unusual for unexpected lymphatic movements and drainage patterns to occur in both healthy-appearing and unaffected anatomic regions ( 22 , 25 ). High-quality lymphoscintigraphy has shown that in over 3,000 patients with melanomas, the trunk of the body frequently demonstrated drainage across the body's midline ( 25 ), and superficial lymph flow moving laterally and a deep lymph flow moving medially has been reported in the back ( 26 ). With NIRLFI, improved imaging technology now captures real-time lymphatic movement, and our understanding of lymphatic movement is undergoing a paradigm shift from defining “normal” flow in healthy patients towards the observation that every patient has their own unique watershed zones that may not be static over time.…”

Section: Discussionmentioning

confidence: 99%

Case Report: The effect of automated manual lymphatic drainage therapy on lymphatic contractility in 4 distinct cases

Aldrich,

Rasmussen,

Karni

et al. 2024

Front. Med. Technol.

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IntroductionAutomated manual lymphatic drainage therapy (AMLDT) is available for home use in the form of a pneumatic mat of 16 pressurized air channels that inflate and deflate to mimic the stretch and release action of manual lymphatic drainage therapy. Four cases (a patient with complex regional pain syndrome and lymphedema, a healthy patient, a breast cancer survivor with chronic pain, and a patient with a history of abdominal surgery) underwent near-infrared fluorescence lymphatic imaging (NIRFLI) with AMLDT to evaluate the effect of AMLDT on lymphatic pumping and pain.MethodsEach patient received 32–36 injections of 25 μg indocyanine green (ICG) on the anterior and posterior sides of their body and underwent 1 h of NIRFLI to assess the drainage of ICG laden lymph toward regional nodal basins at baseline. Each patient lay supine on the mat for 1 h of AMLDT with NIRFLI to assess lymphatic flow during treatment. A final NIFRFLI assessment was done 30–60 min posttreatment with the patient in the supine and prone position. Patients reported baseline and posttreatment pain using the Visual Analogue Scale. An imager analyzed NIRFLI images using ImageJ (US National Institutes of Health). Using time stamps of the first and last images to determine time lapsed and the number of pulses observed in a timeframe, pulsing frequency (pulses/min) was obtained to assess lymphatic function.ResultsAll 4 cases completed the NIRFLI and AMLDT without complications; all 3 patients with baseline pain reported reduced pain posttreatment. AMLDT appeared to alter lymphatic contractility, with both increased and decreased pulsing frequencies observed, including in nonaffected limbs. Pulsing frequencies were very heterogeneous among patients and varied within anatomic regions of the same patient.DiscussionThis proof-of-concept study suggests that AMLDT may impact lymphatic contractility. Further research on its effect on lymphatic function is warranted.

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Section: Discussionmentioning

confidence: 99%

Case Report: The effect of automated manual lymphatic drainage therapy on lymphatic contractility in 4 distinct cases

Aldrich,

Rasmussen,

Karni

et al. 2024

Front. Med. Technol.

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“…It was not possible to explain the heterogeneity of lymphatic drainage of torso; this condition was previously described by Bonmarchand [ 22 ], but the physiopathological mechanism is still unknown. Conversely, classic anatomical literature reported robust evidence that lymph from the skin lumbar region drains into the subscapular lymph nodes [ 23 ]. Otherwise, in groups with homogeneous lymphatic drainage (drainage of the anterior and lateral abdominal wall, upper and lower limb, pectoral and clavicular region, and head–neck region), the two above detection methods could be combined to reduce the number of false negatives in case of larger lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma

Cirocchi

Metaj

Cicoletti

et al. 2021

JCM

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In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p < 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p < 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on the dorsal subscapular region and lumbar region. For this reason, the association of preoperative lymphoscintigraphy with another imaging evaluation is needed in these critical cutaneous areas. Recent technical developments enabling fluorescence lymphography together with indocyanine green have significantly improved the visualization of lymphatic drainage patterns at a microscopic level. In the preoperative phase, any doubt can be resolved by associating the SPET-CT scan to lymphoscintigraphy, while during the intraoperative phase, an additional evaluation with indocyanine green can be performed in doubtful cases. The aim of the duplex lymphatic mapping (pre and/or intraoperative) is an accurate search of sentinel nodes, in order to reduce the rate of false negatives.

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Outline of the Lymphatic System of the Back

Cited by 2 publications

References 0 publications

Case Report: The effect of automated manual lymphatic drainage therapy on lymphatic contractility in 4 distinct cases

Case Report: The effect of automated manual lymphatic drainage therapy on lymphatic contractility in 4 distinct cases

Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma

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